PEPTIC ULCER DISEASE

BACKGROUND

Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain.

Peptic ulcers include:

• Gastric ulcers that occur on the inside of the stomach
• Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum).

DISEASE OCCURRENCE IN POPULATION:

In the west duodenal ulcer is a disease of active years of life while gastric ulcer occurs in elderly which has been attributed to the use of NSAIDs. The pattern of duodenal ulcer in Pakistan is similar to that of developed countries except for minor differences. However, the situation for gastric ulcer is not clear due to the lack of available information.

RISK FACTORS:

In addition to taking certain pain medications, including aspirin, you may have an increased risk of peptic ulcers if you:

• Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.
• Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that's produced.
• Have untreated stress.
• Eat spicy foods.

SIGN AND SYMPTOMS:

The most common symptom of peptic ulcers is abdominal pain.

• The pain is usually in the upper middle part of the abdomen, above the belly button (navel) and below the breastbone.
• The ulcer pain can feel like burning, or gnawing, and it may go through to the back.
• Pain often comes several hours after a meal when the stomach is empty.
• The pain is often worse at night and early morning.
• It can last anywhere from a few minutes to several hours.
• The ulcer pain may be relieved by food, antacids, or vomiting.

Other symptoms of peptic ulcers include the following:

• Nausea
• Vomiting
• Loss of appetite
• Loss of weight

Severe ulcers may cause bleeding in the stomach or duodenum. Bleeding is sometimes the only symptom of an ulcer. This bleeding can be fast or slow. Fast bleeding reveals itself in one of the following ways:

• Vomiting of blood or dark material that looks something like coffee grounds: This is an emergency and warrants an immediate visit to an emergency department.
• Blood in the stool or black, tarry, sticky-looking stools

DIAGNOSTIC TEST:

If you have symptoms of a peptic ulcer, your doctor might do:

• Tests to check for H. pylori infection – Doctors can check for H. pylori infection by doing:
  • Blood tests
  • Breath tests – These tests measure substances in a person's breath after he or she has been given a special liquid to drink
  • Lab tests that check a sample of a bowel movement for the infection
• A procedure called an “upper endoscopy” – During an upper endoscopy, a doctor puts a thin tube with a camera on the end into a person's mouth and down into the stomach and duodenum. Then he or she checks the lining of the stomach and duodenum for ulcers.

TREATMENT OPTIONS:

Antibiotic medications are prescribed if H. pylori bacteria is found in the digestive tract. In this case, antibiotics are taken for two weeks to kill the bacteria.

Drugs that work as proton pump inhibitors help reduce stomach acid by blocking acid producing cells.

A calcium supplement may be needed if taking proton pump inhibitors over the long-term. Acid blocking medications, also known as histamine blockers, reduce the amount of stomach acid going into the digestive tract. These medications also relieve pain symptoms.

Another class of medications called cytoprotective agents may be prescribed to protect fragile tissues that line the small intestine and stomach.

An over-the-counter antacid drug may be added to the medication regimen in order to provide quick pain relief by neutralizing stomach acid. While antacids provide temporary relief of pain, they do not help to heal an ulcer. Sometimes an ulcer fails to heal, which is called a refractory ulcer. Lack of healing may be due to other factors such as resistance to antibiotics, smoking or another disease.

It is important to follow all your doctors' instructions about taking your medicines. Let your doctor or nurse know if you have any side effects from your medicines.

People who have serious problems from their peptic ulcers might also need to be treated with surgery.

PRECAUTIONS:

To help a peptic ulcer heals and to prevent future peptic ulcers, you are suggested to:

• Not smoke
• Not take Nonsteroidal anti-inflammatory drug (if possible)
• Reduce salt intake
• Avoid fatty food
• Alleviate stress
• Avoid milk

REFERENCES:

• http://www.jpma.org.pk/full_article_text.php?article_id=5125
• https://www.uptodate.com/contents/peptic-ulcers-the-basics?source=see_link
• http://www.jpma.org.pk/full_article_text.php?article_id=5125
• http://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/dxc-20231407
• http://www.emedicinehealth.com/peptic_ulcers/page3_em.htm#what_are_the_symptoms_of_a_peptic_ulcer
• https://www.reference.com/health/treat-peptic-ulcer-d57d9ec8a8ff30a8?qo=cdpArticles#

about stress-reduction techniques.